Survey Says!

Picture an episode of the game show "Family Feud." The question: One hundred health care workers were asked, "Name the first feeling you have when you hear the words 'The Joint Commission.' " 

Chances are, when the show's host shouts his famous "Survey says!" line, TERROR will be the top answer on the six-item list. (Followed by fear, anxiety, dread, panic, and shock.)

The Joint Commission (http://www.jointcommission.org) is the organization that accredits most hospitals and many other health care facilities in the United States via so-called "surveys" (a nice phrase for "inspections"). Accreditation is the key to Medicare reimbursement, as well as a generally recognized standard of patient care. So organizations desperately want to comply with The Joint Commission's standards, for both financial and public relations reasons. Complying with these standards, though, can be a challenge, due to the sheer volume of requirements. The updated 2012 version of the CAMH (Comprehensive Accreditation Manual for Hospitals) is more than 750 pages long. No joke; I've got a PDF of it on my laptop. So this terror response to an impending Joint Commission survey is somewhat understandable.

But I believe in The Joint Commission, and its mission statement:

To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. 

Maybe that sounds corny, and naive (given that I am not yet in the trenches of health care work). But I am currently doing freelance editing and writing for Joint Commission Resources, the publishing arm of The Joint Commission. And the materials I have been exposed to have convinced me that overall, The Joint Commission isn't out to punish people, it's out to protect patients, and ensure the best possible care for them. And isn't that what physicians, nurses, and other health care professions should strive for as well?

I am both a journalist and a scientist, and out of service to both of these roles, I will provide evidence to support my claim. Others may or may not agree with me, but I hope that this post will at least provoke some thought, and perhaps some discussion.

First of all, most of The Joint Commission standards I have seen - while complex and extensive - make sense and have a purpose. For example, organizations are required to have a formal, written "Emergency Operations Plan" (EOP) that takes what is called an "all-hazards" approach to emergencies. Basically, what this means is that a hospital (or other facility) has to be prepared for whatever may happen, along with having specific steps and procedures in place for dealing with certain types of more likely situations such as fires. The EM (Emergency Management) standards and related EPs (Elements of Performance, which are basically broken out objectives) literally comprise 20 pages of the CAMH. There are standards related to evacuation, utilities management, licensing of independent practitioners in event of a disaster, and many other scenarios and issues. That's a lot to keep track of, obviously. But think of it this way - if you were a patient, or had an ill family member in the hospital, wouldn't you want a hospital to have such a plan in place and ready to initiate at a moment's notice? Without such a plan, an emergency or disaster would cause absolute mayhem. Of this I am completely convinced. 

One of the things I have enjoyed most (and also benefited from) with regard to my freelance work for Joint Commission Resources is reading case studies related to implementation of certain standards. For example, one of the case studies I read involved a small community hospital that faced a major hurricane. The hospital lost power, and risked losing generator capability as well, so was forced to evacuate all of its patients to surrounding facilities. Without electricity, though, such an endeavor is a feat. Consider that the hospital was several stories tall, and the elevators were out of service. So non-ambulatory patients had to be carried down the stairs on gurneys. Remember also that without electricity, photocopy machines were not working. Which meant it was impossible to copy patients' charts prior to their transfer elsewhere. The solution to this problem was that hospital staff accompanied patients to the transfer locations, copied the charts there, and brought the original charts back to the community hospital (because both locations needed the patients' records). While the case study (and the hospital administrators) acknowledged room for improvement, and a few hiccups in the process, for the most part this complicated evacuation went pretty smoothly. And that was because the hospital had a detailed EOP. 

Second, The Joint Commission genuinely (in my opinion) tries to provide resources to help hospitals better comply with all of these standards (via Joint Commission Resources publications). Many of these resources are articles and books that specifically address complex standards. Some of them are best-practice examples from organizations that have gone above and beyond in developing a particular policy, procedural checklist, etc. I have been working with Joint Commission Resources to secure permissions for some of these best-practice examples, and have seen how Joint Commission standards can inspire organizations to improve their own workflow, procedures, and policies with the ultimate goal of providing improved patient care. 

Third, I have been inspired. I know I'm not even in medical school yet, much less a practicing physician facing a Joint Commission survey. But some of the case studies, and responses to Joint Commission standards, have given me ideas on how to better provide patient care in my capacity as a Spanish medical translator, as well as ideas for patient care practices in my future as a doctor. For example, one case study I read referenced the development and use of something called a "Patient Care Notebook." This was in response to miscommunications and accidental gaps in care, especially after a patient was discharged from the hospital and went into the outpatient setting (or vice versa). The Patient Care Notebook is just that - a notebook (rather, a three-ring binder) with dividers for different types of information, medication logs, doctor's visit logs, space for patients to write down their own questions (and the practitioners' answers), important contact information, discharge papers, care plans, etc. This helped organize a patient's medical information in one place, and provided a tool for both the patient and his or her practitioners. It was something the patient could bring to every visit, hospital stay, etc., and add (or remove) information (medications, etc.) as time went on. 

As I came across this, I thought to myself, "How brilliant!" I immediately e-mailed the community outreach coordinator at the clinic where I volunteer, to see whether she might be interested in incorporating this tool into the patient health literacy initiative she is working on (and I am helping with). I also realized that this type of tool is something I could develop and customize for my own patients in the future, as it is not readily commercially available. (Which does not make sense to me at all, given how beneficial it has the potential to be.)

So if I were one of the health care survey respondents, and was asked that question I posed at the beginning of this post, my answer would be different: "Gratitude."